Healthcare Provider Details

I. General information

NPI: 1851255301
Provider Name (Legal Business Name): SANTAQUIN DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 E MAIN ST
SANTAQUIN UT
84655-7267
US

IV. Provider business mailing address

451 E MAIN ST
SANTAQUIN UT
84655-7267
US

V. Phone/Fax

Practice location:
  • Phone: 801-658-0221
  • Fax: 801-658-0232
Mailing address:
  • Phone: 801-658-0221
  • Fax: 801-658-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KYLE R MARSHALL
Title or Position: OWNER
Credential:
Phone: 801-658-0221